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There must be many more people who are either asymptomatic or if symptomatic they are hiding their symptoms because of fear being isolated or mal-treated by community. Some also fear losing their job, or are essential carers for their family and cannot spare themselves to isolate. There are also limited test kits available. Therefore, assessing the actual number of COVID 19 positive people in the country is next to impossible. During the last two weeks, 14 registered dialysis patients tested COVID 19 positive, but many were not tested for various reasons.
Registered dialysis patients may hide their symptoms because of fear that they might be deprived of life saving treatment, which is not reality as all big nephrology centers in country have designed their guidelines for dialysis patients and have plans to deal with dialysis patients found to be COVID 19 positive. In addition, health care personnel with limited resources sometimes take decisions which may lead to psychological trauma. It is challenging to decide whether to direct them towards the area designated for COVID 19 patients at any renal unit or proceed with their emergency procedures of attaining angio-access and starting dialysis as per routine.
SIUT has started doing screening of the general population non-renal and is one of state designated institution for performing tests. The Center of Biomedical Ethics and Culture CBEC at SIUR has also developed a set of concise guidelines providing a broad ethical framework for making decisions, though the main focus is to address areas like allocation of scarce resources such as ICU beds or providing mechanical ventilation. Contributor Dr Marjorie Foo. Singapore has approximately prevalent dialysis patients and. As of April 14, there has been cases giving incidence of approximately pmp with 9 deaths 0.
Patients who tested positive will be transferred to isolation rooms with dialysis capability.
High-alert areas enforces higher level of personal protection equipment to be worn. Doctors and nurses are segregated to frontline or routine in- and out-patient care areas. The team worked with facilities department to identify isolation rooms with dialysis capability while sourcing for more dialysis paraphernalia like portable reverse osmosis machines and looking for areas for expansion. Transplant program was put on hold. Community HD centres follow advisory from the Ministry of Health MOH with regards to screening and discourages change of shifts for patients and nurses for ease of contact tracing.
Confirmed cases are sent to NCID and contacts are isolated at home with dedicated transport to bring them to designated dialysis centres. Tele-nephrology in HD centres are rapidly scaled up to fast track failing access for treatment, minimising hospitalisation. PD centre continues to train patients, conforming to social distancing and wearing masks at all times. Home visits are only performed in special cases where without which will result in hospitalisation.
Virtual treatment monitoring and 24hr hotline for technical and clinical services strengthened patient home support. Palliation services continues with screening in place. Nephrologists set up secure chat groups to discuss treatment strategies, resource and manpower management; aligning treatment criteria to optimise use of consumables. There needs to be constant monitoring of resources at a local and national level as well as keeping census across the country for updates of AKI cases and outcomes.
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Peer support group is set up to monitor for burn-out. Contributor Dr Gheun-Ho Kim. As of April 5, , overall 10, patients were diagnosed to have the infection.
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Among them, 14 patients, 8 medical personnel, and 2 caregivers were diagnosed with COVID in hemodialysis units through April 5, Two dialysis patients died, but no mortality was from healthcare workers. This situational change must have imposed a physical and psychological burden to the patients. They may have felt panic or depressed about isolation treatment. For dialysis centers where COVIDinfected cases occurred, nurses were redistributed among the affiliated hospitals of a university.
When confirmed or suspected cases were found in the dialysis unit, they were spatially and temporally separate from other dialysis patients. In Daegu, 14 dialysis patients and 10 healthcare workers physician 1, nurses 7, caregivers 2 were infected. Many patients and healthcare workers were unable to work because of self-imposed quarantine. The health official epidemic control commissioner discerned contacts by CCTV records etc. Dialysis patients were educated about personal hygiene such as hand washing, wearing masks, and avoiding unnecessary contact.
The surgical masks and hand sanitizer should be available at the entrance of the HD unit. The healthcare workers, HD patients and their caregivers should perform standard, contact, and droplet precautions including hand hygiene and wearing masks.
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Each HD unit should prepare the adequate environment to minimize infection transmission such as keeping the proper distance between beds. The waiting room or resting area should be closed and each HD patient should come in at a reserved time to minimize patient-to-patient contact. Before arrival at the HD unit, all HD patients should be asked about their prior visit to other countries and domestic outbreak regions, any patient contact history, and their clinical symptoms.
In addition, if the patient has a fever, cough, or shortness of breath, they should call first and let the healthcare worker know about their symptoms before they visit the HD unit.
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Each HD unit should prevent secondary transmission of infection by restricting the caregivers or visitors not to come in the HD unit. Contributor Dr Bassam Saeed. To date, no patients on dialysis or on immunosuppressive treatment due to glomerulonephritis or having a kidney transplant have been admitted or known to have COVID infection. There are Syrians receiving maintenance dialysis treatment. As of April 11, , a total of 25 Covid positives were reported inside Syria since the beginning of this pandemic. Interestingly, none of them were found to have any kidney disease.
Because testing kits for confirming COVID infection were not available in sufficient quantities at the start of the pandemic in the country, diagnostic tests were performed only for those who are in critical condition or need hospitalization. Consequently, one could speculate that only severe cases were diagnosed while a much higher number of infected people remain undiagnosed just because they have mild presentations or they are simply asymptomatic. Recently, things seem a bit better as testing for the virus becomes more accessible.
On average a total of tests are being done on a daily basis and efforts are being made to perform up to tests a day. In April 05, ; The Syrian Technical and Advisory Team for Corona Pandemic Treatment held a meeting and came out with a treatment protocol based on patient characteristics, phase of illness and disease severity using antivirals and immunosuppressive agents.
This protocol is based on empirical observations in other countries.
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The government has instructed public to stay at home if not at work and suspended all schools, colleges, shopping malls and other shops except pharmacies, medical clinics, and food shops. The government imposed a partial curfew from 6 PM to 6 AM with heavy penalties. All patients on dialysis are advised to respect social distancing rules since early stages of the coronavirus crisis.
Standard contact and droplet precautions, including isolation gowns, gloves, masks, and eye protection and other; personal protective equipment PPE have been implemented. Routine disinfection practices including disinfection wipes for the dialysis machine, chair, and all dialysis station surfaces and equipment are being used.
Preserving and prioritizing PPE for healthcare workers and patients is a challenge. Another crucial challenge is management of workforce. Actions were taken such as creating alternate schedules and limiting prolonged exposure to clinical areas. We adopted surveillance measures for outpatients undergoing hemodialysis. These were applied in locations for donning and doffing PPE with temperature checks, brief clinical evaluation, provision of alcohol-based hand sanitizer and surgical masks.
In case of urgency for dialysis treatment, this must be performed in an isolation room intended for suspected cases. Many dialysis units rearranged spaces to create hemodialysis rooms, intended partially for COVID positive patients. Most of our patients with COVID typically had mild symptoms and survived the infection with no complications.